Nutrition & fluid balance digestive (class 6)

Question 1

factors affecting nutritional status in elderly

Answer 1

changes in appetite, taste, smell, and GI affect nutrition.

decrease income contributes to food intake.

dentures, missing teeth, pain from poor oral hygiene.

chronic illness/depression

multiple medications

cognitive impairment/dementia

living in LTC facility.

Question 2

elderly nutrition teaching

Answer 2

maintain healthy weight.
chose nutrient dense foods.
oral care BID
avoid processed foods & high fat foods.

Question 3

nutritional needs in elderly

Answer 3

metabolism slows with age less calories needed.
vitamin and mineral needs same.
iron needs drop for post-menopausal women.
vitamin D synthesis reduced.
vitamin B12 reduced.
fluids-about 8 cups/day.
limit alcohol, refined sugars, fat, and salt.
zinc deficiency can alter taste.

Question 4

risk factors of dehydration in elderly

Answer 4

purposely restrict their fluids.
loose sense of thirst.
forget to drink.
cannot get fluids on their own.
No a/c in summer.

Question 5

s/s dehydration in elderly

Answer 5

confusion-change in mental status early s/s dehydration.
dry tongue & mucous membranes (furrowed tongue).
skin turgor less reliable (sternum or inner thigh)

tachycardia
subnormal temperature.
pinched facial expression
hot dry body.

Question 6

nursing interventions

dehydration in elderly

Answer 6

I&O. daily weight (3% loss sign of dehydration).
monitor electrolyte levels.
assessment for deficient fluid volume.
encourage fluids.
call light in reach.
review orders for NPO status & notify physician for late & cancelled tests.

Question 7

Oral cancer

Answer 7

malignancy of oral mucosa on lips, tongue, floor of mouth, or oral tissues.

high morbidity & mortality.
40 years old most common.

Question 8

oral cancer

risk factors

Answer 8

smoking, drinking alcohol, chewing tobacco, HPV-recent studies have found.

Question 9

oral cancer

symptoms

Answer 9

early: painless ulcer or lesion.
later: difficulty speaking, swallowing, or chewing, swollen lymph nodes, blood-tinged sputum.

leukoplakia: white patch smokers patch.
erythroplakia: red vevety patch.

any oral lesion that doesn’t heal/respond to Tx in 1-2 weeks should be evaluated for malignancy.

Question 10

oral cancer

treatment/prevention

Answer 10

eliminate causative factors (smoking, tobacco, ETOH)
oral sex & HPV transmission.
regular dental care.

stages I&II are highly curable: surgery & radiation.

stage III&IV require combination: surgery, radiation, & chemotherapy. radical neck dissection with tracheostomy.

Question 11

effects of oral radiation

Answer 11

males may experience permanent loss of hair in area of their beard.

skin irritation and lack of salivary function-worse as treatment continues.

salivary function may not return to normal: keep mouth moist, HOB elevated, Additional fluids.

Question 12

esophageal cancer

Answer 12

uncommon & high mortality rate.
<5% survive 5 yrs after diagnosis.
most tumors in lower 1/3 of esophagus

Question 13

esophageal cancer risk factors

Answer 13

cigarette & chronic ETOH abuse.
opiate smoking.
ingested carcinogens.
chronic reflux.
physical mucosal damage.

Question 14

esophageal cancer

symptoms

Answer 14

most common: progressive dysphagia & recent weight loss. 
anemia.
GERD-like symptoms
anorexia
chest pain
persistent cough.

Question 15

esophageal cancer

goal

Answer 15

control dysphagia and maintain nutrition regardless of treatment

Question 16

esophageal cancer

diagnosis

Answer 16

bronchoscopy.
barium swallow
chest xray, CT scan, MRI look for metastasis

Question 17

esophageal cancer treatment

Answer 17

radiation therapy and or chemotherapy
esophagectomy & possible anastomosis of the stomach to remaining esophagus.
NG tube often post op plaed in OR

Question 18

esophageal cancer

complications

Answer 18

anastomosis leak.
respiratory complications (pneumonia, acute respiratory distress syndrome)
gastric necrosis or bleeding
infection & sepsis.

Question 19

stomach cancer

risk factors

Answer 19

H. pylori infection is majore factor 60-90%.
genetic.
chronic gastritis.
gastric polyps.
carcinogens in the diet (smoked foods & nitrates)
history of partial gastric resection.

Question 20

stomach cancer

symptoms

Answer 20

early symptoms: very few.
vague-feeling of early satiety. anorexia, indigestion and vomiting.
ulcer-like pain unrelieved by antacids after meals.

advanced disease: weight loss.
cachectic (malnourished & poor health)
palpable abdominal mass.
occult blood in stool

Question 21

stomach cancer

diagnosis

Answer 21

anemia may be first symptom (CBC)
upper GI with barium swallow xray
ultrasound
upper endoscopy with visulatization and biopsy of lesion=provides definitive diagnosis.

Question 22

stomach cancer

treatment

Answer 22

removal of part of all of the stomach.

Question 23

post-op nursing care for gastrectomy

Answer 23

assess NG tube & suction as ordered.
do not replace or move tube. call DR.
assess color amount & odor of gastric drainage. initial NG output is bright red then to green-yellow over 2-3 days. if excessive amount of bright red, call DR.

monitor bowel sounds and distention.
encourage ambulation.
monitor weight.

Question 24

complications of gastrectomy

Answer 24

dumping syndrome common: food eaten enters small intestine too quickly, gastric surgery makes it more difficult to regulate movement.

s/s: occurs 5-30 mins after eating.
feeling full, abd cramping, nausea, vomiting, severe diarrhea, sweating, flushing, or light-headedness, rapid heartbeat, loud hyperactive bowel sounds, hyperosmolar chyme in the jejunum causes rapid rise in glucose & release of excessive insulin. hypoglycemia common 2-3 hr after meals.

Question 25

dumping syndrom management

Answer 25

small frequent meals, liquids & solids taken at separae times not together. increase protein & fats. reduce CHOs especially simple sugars. recumbent/semi-recombent 30-60 min after meals. monitor nutritional status.

Question 26

liver functions

Answer 26

metabolism of proteins fats & CHO. produces bile for fat absorption & eliminates bilirubin from body. detoxifies ETOH & other toxic substances. inactivates drugs/limits duration of effects. metabolism of steroid hormones & most drugs. makes blood proteins. ammonia is converted to urea for kidneys to excrete. minerals and fat soluble vitamin storage. stores iron as ferritin which is released as needed for RBC production.

Question 27

common manifestations of liver disorders

Answer 27

hepatocellular failure. jaundice. portal hypertension

Question 28

hepatocellular failure

Answer 28

liver is vital to: digestion & metabolism of nutrients. production of plasma proteins. clotting proteins. albumin. metabolism & excretion of bilirubin, steroid hormones, toxins, and ammonia. note: albumin keeps fluid in the vessels. low albumin=fluid leaks out of vessels causing edema/ascites.

Question 29

hepatocellular failure. | impaired function of liver cell causes

Answer 29

decreased production of albumin r/t impaired protein metabolism. decreased production of clotting factors. decreased bile production which impairs absorption of lipids & fat soluble vitamins (VIT K affects production of clotting factor.) impaired metabolism of steroid hormones causing: feminization of men & irregular menses in women.

Question 30

hepatocellular failure/jaundice

Answer 30

RBCs breakdwon & form bilirubin. when bilirubin cant be emulsified & digested through bile it builds up causing yellow appearance. accumulation of bilirubin in tissues caused by disruption in metabolism of bilirubin=yellow color reflected in skin , mucus membranes, sclera.

Question 31

protal hypertension

Answer 31

impaired blood flow through liver increases pressure venous system that drains the GI tract, spleen, & surface veins of the abdomen causing: veins in GI tract & abdominal wall to dilate causing: appetite suppresion, formation of collateral vessels in esophagus, rectum, & stomach. esophageal varices, hemorrhoids, caput medusa. ascites: increased pressure in abd vessels causes fluid to leak out. worse by low albumin levels. hepatic encephalopathy build up of ammonia waste product causing mental status changes.

Question 32

diagnostic studies of hepatic function

Answer 32

labs: ALT(alamine aminotransferase) AST(asparate aminotransferase) ALP(alkaline phosphatase) bilirubin total direct (conjugated) indirect (unconjugated) albumin: protein in plasma produced by liver. decrease levels cause fluid shift from vessels into tissues causing edeme & ascites. increased levels seen in dehyrdation ammonia: a by product of protein metabolism converted by liver to urea for excretion by kidneys. increase levels can cause confusion, behavioral & personality changes. low protein diet.

Question 33

paracentesis

Answer 33

aspiration of fluid from peritoneal cavity.

Question 34

paracentesis NI pre procedure

Answer 34

``` void prior to decrease risk of bladder puncture. weight and abdominal girth measurements. R provides measure of effectiveness of procedure. position seated (side of bed or chair) with feet supported. sllow fluid to collect in lower abdomen facilitating removal. ```

Question 35

paracentesis | post procedure

Answer 35

monitor puncture sites & vitals for s/s of hypovalemia. may be some leaking at puncture site-normal depedning on how much fluid remains. weight and abdominal girth @ umbilicus. record amount color clarity of fluid removed no more than 2L removed generally. albumin often given to retain fluid in vascular system & decrease complications.

Question 36

liver biopsy

Answer 36

performed to: r/o cancer, detect cysts. detect cirrhosis. * * need driver home. NPO 4-6 hrs prior, signed consent. place on right side 1-2 hr after. bedrest 8-10hr after procedure home. light activity 1-2 wk after. ask about anticoagulants taken or NSAID use. teach: pain in right shoulder common as local anesthetic wears off.

Question 37

prothrombin time (PT/ pro time)

Answer 37

measures clotting ability of fibrinogen and prothrombin. increase levesl can indicate liver disease. normal range 10-13

Question 38

common hepatotoxins

Answer 38

drugs: isoniazid, acetaminophen, thiazides, tetracycline, statins, steroids, alcohol, some herbal supplements.

Question 39

cirrhosis

Answer 39

fibrosis (scar tissue) of liver tissue leading to: decrease mass, impaired liver function, altered blood flow. thought to be irreversible but fibrosis may be reversed when underlying cause eliminated.

Question 40

types of cirrhosis

Answer 40

alcoholic: lannec's posthepatic: (hapatotoxic, viral hepatitis, nonalcoholic fatty liver r/t obesity, autoimmune hepatitis) Biliary: obsructions. alcoholism major cause.

Question 41

multisystem effects of cirrhosis

Answer 41

ascites- accumulation of plasma fluid in abdominal cavity. pt in semi fowlers positiion to facilitate breathing. bleeding-decreased clotting factor, platelt destruction, & impaired vit k absorption. esophageal varices & hemorrhoids: increase pressure inportal system & thin walled vessels cause this.

Question 42

mutlisystem effects of cirrhosis

Answer 42

encephalopathy: r/t build up of ammonia as liver cannot convert to urea for excretion. integumentary: pruritis r/t build up of toxins. malnutrition- r/t impaired fat & nutrient absorption. supplements needed.

Question 43

maifestations of cirrohisis

Answer 43

malaise, fatigue r/t anemia, GI-gastritis, anorexia, diarrhea. malnutriton: malabsorption of vitamins. fluid retention-edema/ascites. jaundice-liver & bile duct inflammation prevents bilirubin from being excreted into small intestine. bleeding-bruising. encephalopathy pain & pruritis.

Question 44

cirrhosis management

Answer 44

TIPS procedure( trans jugular intrahepatic portosystemic shunt) relieves portal HTN & complications of esophageal varices & ascites. needle inserted transcutaneous creating a channel. expandable metal stent inserted to allow blood flow from portal vein to hepatic vein. bypasses the cirrhotic liver. short term treatment until liver transplant.

Question 45

liver tumors

Answer 45

primary liver cancer uncommon. prognosis poor r/t advanced by time diagnosed.

Question 46

risk factors of liver tumors

Answer 46

chronic hep B & C infections. cirrhosis. chronic alcohol consumptions. non-alcoholic fatty liver.

Question 47

s/s liver tumors

Answer 47

``` jaundice ascites, edema extreme weakness. GI bleeding, bleeding tendancies. high AFP alpha=fetoprotein. encephalopathy. spreads quickly painful palpable mass RUQ ```

Question 48

liver tumor diagnostics

Answer 48

CT scan. MRI liver biopsy

Question 49

liver tumor treatments

Answer 49

radiation, chemo, tumor excisions, liver transplant.

Question 50

hepatitis

Answer 50

inflammation of the liver usually caused by virus. can be acute or chronic. chronic hepatitis increases risk of liver cancer.

Question 51

viral hepatitis

Answer 51

hep A, B, C, D, E virus.

Question 52

chronic hepatitis

Answer 52

primary cause of liver damage leading to cirrhosis & liver cancer cuase but HBV HCV HDV.

Question 53

fulminant hepatitis

Answer 53

rare rapid progression liver failure 2-3 wk associated with HBV and HDV

Question 54

autoimmune hepatitis

Answer 54

body attacks itself.

Question 55

pre-icteric(prodromal) phase hepatitis

Answer 55

begins abrupt or insidiously. malaise, fatigue, anorexia, muscle aches. often mistaken for flu.

Question 56

icteric (jaundiced) hepatitis

Answer 56

begins 5-10 days after onset of symptoms. jaundice sclera, skin, mucous membranes. pruritus r/t bile salts on skin. stools light brown or clay r/t bile not excreted in stool. brown urine from bile pigment excreted y kidneys instead.

Question 57

recovery/posticteric phase hepatitis

Answer 57

follows jaundice & lasts several weeks. s/s gradually improve. serum enzymes decrease.

Question 58

carrier states

Answer 58

carrier state is when an infected person harbors active virus & is capable of spreading it to others even though there are no manifestations of the disease. hep B & C associated with carrier states.

Question 59

hep A

Answer 59

infectious hepatitis. prevent: Hep A vaccine. give immunoglobulin IM within 2 wk of exposure. transmission- fecal-oral via contaminated food, water, or direct contact with infected person. present in stool up to 2 wks before s/s present. risk factors & onset: internation travel, close household contact, abrupt onset, self-limiting disease.

Question 60

hep B

Answer 60

can cause acute, chronic, rapid progressing hepatitis. associated with a carrier state. may be asymptomatic. preventable vaccine available. hep B immunoglobulin IM within 24 hr exposure. transmission contact with infected blood & body fluids. high risk: injection drug users. multiple sex partners & gay sex. exposure to frequent blood products. healthcare workers thru blood & needle stick injury. complications: primary liver cancer-especially if infected perinatally.

Question 61

hep C ** no vaccine available. treat with interferon (antiviral)

Answer 61

primary cause or chronic hepatitis, cirrhosis, & liver cacner. acute hepatitis usually asymptomatic. transmission: infected blood & body fluids. risk factors: injection drug use primary. s/s chronic: fatigue, hepatomegaly, occasional jaundiced periods, liver enzymes elevated.

Question 62

labs for hepatitis

Answer 62

ALT increase, AST inrease, ALP increase, serum bilirubin increase, viral antigen & specific antibodies-identifies virus & state of activity. liver bipsy-detect & evaluate for chronic hepatits.

Question 63

pancreas function

Answer 63

glanular organ that provides 2 functions (exocrine & endocrine) produce enzymes that affect control of digestive enzymes. produce hormones for carbohydrate, fat, and protein metabolism.

Question 64

pancreatitis

Answer 64

inflammatory disorder involves self destruction of pancreas by its own enzymes. leads to hemorrhage & necrosis. exact causes unknown. alcoholism & gallstones primary risk factors for acute pancreatits. acute or chronic

Question 65

diagnostic tests pancreatic function

Answer 65

serum amylase inrease in pancreatitis. serum lipase increase. endoscopic retrograde cholangiopancreatography (ERCP) diagnostic for chronic pancreatitis to differentiate fibrosis from carcinoma.

Question 66

acute pancreatitis

Answer 66

often mild & self limiting. reversible. abrupt onset of epigastric & LUQ pain. gallstones leading cause. ETOH 2nd cause.

Question 67

interstitial edematous pancreatitis

Answer 67

milder leads to inflammation & edema of pancreatic tissue.

Question 68

necrotizing

Answer 68

more sever leads to inflammation, hemorrhage, and necrosis of pancreatic tissue.

Question 69

pathophysiology of acute pancreatitis

Answer 69

activated pancreatic enzymes released into pancreas. enzymes, trypsin, digests pancreatic tissue & activates other enzymes. other enzymes digest blood vessel walls causing vasoldilation leading to edema. fluid volume shifts from circulation blood into retroperitoneal spaces of abdomen. hypovolemic shock & renal failure can develop 24 hr after onset.

Question 70

chronic pancreatitis

Answer 70

chronic inflammation, fibrosis, gradual destruction of pancreatic tissue. irreversible alcoholism primary risk factor in US. ETOH- pancreatic secretions have insoluble proteins that calcify & block pancreatic ducts & flow of pancreatic juices 10-20% idiopathic. recurent infammation.

Question 71

acute

Answer 71

reversible, onset abrupt/24 hr. gallstones leading cause. complications: intravascular volume depletion, renal failure, acute resp distress syndrom.

Question 72

chronic

Answer 72

irreversible. onset gradual destruction alcoholism leading cause. complications:malabsorption & malnurtition. increase risk of pancreatic cancer. opioid addiction r/t pain.

Question 73

acute manifestations

Answer 73

``` abrupt sever epigastric LUQ pain. N/V, fever, decrease bowel sounds, abd rigidity & distention. tachycardia, hypotension, cold clammy skin. possible jaundrive. turner+(flank bruisng) Cullen sign (peri-umbillical bruising) ```

Question 74

chronic manifestations

Answer 74

recurrent epigastric & LUQ pain radiating to back. anorexia, nausea, vomiting, weight loss, flatulence, constipation, steatorrhea (fatty foul smelling stool)

Question 75

acute treatment

Answer 75

supportive: pain meds. NPO, IVF to maintain vascular volumer. TPN nutrition while NPO. low fat high CHO diet when bowel sounds +, pain relieved, & amylase normalizes 3-4days. surgery if cause gallstones.

Question 76

chronic treatment

Answer 76

pain meds-monitor dependence. enzyme supplements-manage abd pain & reduce steatorrha. high CHO low fat diet with frequent feedings. H2 blockers & ppo to neutralize gastric secretiosn

Question 77

pancreatic cancer

Answer 77

uncommon <3% of cancers but one of most letha.

Question 78

pancreatic cancer risk factors

Answer 78

cigarette smoking 2x higher risk, chronic pancreatitis, DM, cirrhosis, obesity, high fat diet, genetic predisposition.

Question 79

pancreatic cancer manifestations

Answer 79

few s/s until advanced. dull epigastric pain that increases as tumor grows. wt loss, flatulence.

Question 80

pancreatic cancer treatment

Answer 80

early may be able to resect head of pancreas (whipple) pancreatoduodenectomy (WHipple) radiation, chemo.

Question 81

post-op whipple complications

Answer 81

hypovolemic shock, hemorrhage, bile leak, hepatorenal failure.

Question 82

whipple procedure

Answer 82

done when cancer found early. removes head of pancreas, entire duodenum, distal 1/3 of stomach, portion of jejunum

Question 83

whipple procedure nursing care

Answer 83

semi-fowlers-facilitate lung expansion, reduce stress on suture line. maintain NG low int. sx keep patent. do not reposistion puts stress on suture lines. no forceful NG irrigations-stress on suture lines.